New Persistent Opioid and Benzodiazepine Use After Curative-Intent Treatment in Patients With Breast Cancer

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  • 1 Department of Medicine,
  • 2 Department of Health Systems, Management, and Policy,
  • 3 Division of Medical Oncology, Department of Medicine, and
  • 4 Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Background: Opioid and benzodiazepine use and abuse is a national healthcare crisis to which patients with cancer are particularly vulnerable. Long-term use and risk factors for opioid and benzodiazepine use in patients with breast cancer is poorly characterized. Methods: We conducted a retrospective population-based study of patients with breast cancer diagnosed between 2008 and 2015 undergoing curative-intent treatment identified through the SEER-Medicare linked database. Primary outcomes were new persistent opioid use and new persistent benzodiazepine use. Factors associated with new opioid and benzodiazepine use were investigated by univariate and multivariable logistic regression. Results: Among opioid-naïve patients, new opioid use was observed in 22,418 (67.4%). Of this group, 611 (2.7%) developed persistent opioid use at 3 months and 157 (0.7%) at 6 months after treatment. Risk factors for persistent use at 3 and 6 months included stage III disease (odds ratio [OR], 2.16; 95% CI, 1.49–3.12, and OR, 3.48; 95% CI, 1.58–7.67), surgery plus chemotherapy (OR, 1.44; 95% CI, 1.10–1.88, and OR, 2.28; 95% CI, 1.40–3.71), surgery plus chemoradiation therapy (OR, 1.47; 95% CI, 1.10–1.96, and OR, 2.34; 95% CI, 1.38–3.96), and initial tramadol use (OR, 2.66; 95% CI, 2.05–3.46, and OR, 3.12; 95% CI, 1.93–5.04). Among benzodiazepine-naïve patients, new benzodiazepine use was observed in 955 (10.3%), and 111 (11.6%) developed new persistent use at 3 months. Tamoxifen use was statistically significantly associated with new persistent benzodiazepine use at 3 months. Conclusions: A large percentage of patients receiving curative-intent treatment of breast cancer were prescribed new opioids; however, only a small number developed new persistent opioid use. In contrast, a smaller proportion of patients received a new benzodiazepine prescription; however, new persistent use after completion of treatment was more likely and particularly related to concurrent treatment with tamoxifen.

Submitted February 20, 2020; accepted for publication June 26, 2020.

Author contributions: Study concept and design: Sakamoto, Eguchi, Bradley, Kabos. Data acquisition and analysis: Eguchi, Bradley. Data interpretation: Sakamoto, Bradley, Kabos. Methodology: Sakamoto, Eguchi, Bradley, Kabos. Manuscript writing: Sakamoto. Manuscript review and editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This project was supported by Population Health Shared Resource, University of Colorado Cancer Center, P30CA046934; NCI grant CA229551 (C.J.B.), and NCI grant CA20544 (P.K.).

Correspondence: Peter Kabos, MD, Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 East 17th Avenue, Aurora, CO 80045. Email: Peter.Kabos@cuanschutz.edu; and Cathy J. Bradley, PhD, Department of Health Systems, Management, and Policy, University of Colorado Comprehensive Cancer Center, 13001 East 17th Place, Mail Stop B119, Aurora, CO 80045. Email: Cathy.Bradley@cuanschutz.edu

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